Renovating healthcare facilities is intricate and implementation takes high levels of energy, tenacity and perseverance from staff, patients and the community. Health leadership should bring quality to life through campaigning for quality assurance in implementation through meaningful engagement with research which provides evidence to support continued commitment to quality of care during such endeavors.
Psychiatric or mental health patients are a vulnerable group in the healthcare scenario,especially if they are admitted to a healthcare facility which is under construction for the purposes of upgrades. The WHO fact sheet of April 2016 , titled Mental Health: Strengthening our response calls for strengthening of effective leadership and governance, as well as evidence and research for mental health. Ministries of health will need to take a leadership role guided by WHO to work with persons with mental disorders and enable them to participate in the reorganization, delivery and evaluation of services so that care becomes more responsive to their needs.
A doctoral study critically evaluated the implementation of a hospital revitalization project in Paarl, South Africa, which aimed to modernize and transform the infrastructure and health technology of the hospital whilst improving quality of care and access to public health care. This project included a phase for a Psychiatric unit. A drive by the National Department of Health in South Africa to improve the quality of health care through the National Core Standards calls on leadership in this health sector to facilitate initiative and change in practice. Research on quality of care in health thus fulfils a practical mandate to create information for use by nursing leaders to improve and inform practice.
The outcome of the study was the development of an innovative framework for project implementation, which was tried and tested in an intervention study against the needs of Psychiatric patients, A descriptive case study design, with qualitative research methodology was selected. The case study involved an intensive exploration of the circumstances, dynamics and intricacies of this public hospital project. The multi-method approach to data collection included focus group discussions; individual and pair interviews; as well as photographic and document review. Action research methodology was conducted with its intent of collaborative knowledge enquiry and sharing. The findings that arose during the main study were simultaneously used to develop a project implementation framework. By application of this framework, action was taken to improve project implementation in the planning and decanting stage of the Psychiatry clinical unit.
The Psychiatry intervention included multi-sectoral collaboration with nurse leadership, engineering and architectural consultants and a local mental health non-profit organization, whom established a healing garden for patients. This collaboration facilitated liaison with the community, chronic psychiatric patients in the community and the hospital.
The intervention study findings indicate that the proposed hospital revitalisation implementation framework reduces risk to client, staff and technical quality domains during implementation. This study found that nursing professionals need to be an integral part of hospital construction project planning. Nursing leaders must claim the space at the point around which community and other stakeholders pivot in the interest of best practice for psychiatric patients and healthcare providers involved in hospital renovation projects.
The proposed implementation framework serves to inform of the risk management strategies for the infrastructure, health technology, and quality assurance deliverables of future hospital revitalization projects where mental healthcare is delivered. Theoretical models are put forward to supplement project implementation in each specific component. Roger’s (1983)theory on diffusion of innovation provides a broad framework for the hospital revitalisation project innovation assimilation and implementation in the health service.
The framework also includes guidelines for hospital upgrade business case development; design considerations and the quality direction focus in the golden triangle of project stewardship. Nursing leaders stand to benefit from the framework in the interest of affordable (economically effective and efficient allocation of public resources), acceptable, appropriate, timely and good quality health for all.
This research could contribute to advancing hospital revitalisation policy implementation in practice by nurse leaders for the staff involved and their Psychiatric patients affected by re-engineering of operational health facilities. Such evidence-based decision-making could serve as sound recommendations to influence policy around hospital revitalisation.
The findings thus provide nurse leaders globally with innovative research, which has produced evidence-based practice strategies in the shape of a pragmatic, tangible framework for Psychiatric patient and staff safety; as well as risk management outcomes during health facility infrastructural upgrades.